S.C.I.D. Danger

Well my DBT pre-commitment sessions are drawing to a close.  One more to go and then I start the programme properly.

In this penultimate session Joy explained that we’d pretty much covered all the pre-commitment work and there was one more baseline assessment to do.  This time not a multi choice questionnaire but a s.c.i.d.  This immediately made me think of dirty pants but Joy went on to explain it was a diagnostic tool for Borderline Personality Disorder.  

S.c.i.d. is an acronym for Structured Clinical Interview  for DSM disorders (DSM being an acronym for a diagnostic manual of some sort).  Confused by acute ‘acronymitus’, I preferred to revert to my own understanding of ‘skid’ – “a dirty stain on clothes or fabric caused by a pooey bottom.”  It turned out this wasn’t such a bad interpretation.

The interview took the form of a series of questions covering a range of the BPD diagnostic criteria.  These were asked by Joy who was able to ask me to explain further or clarify any of my answers.  It also meant when I said, “No, I don’t do or experience that!” she was able to ask about it in a different way to make sure.  

I’m not quite sure why we did it.  I had to have a BPD diagnosis to be referred to do the DBT in the first place – though she did say that if I put the work in I could expect not to meet the criteria anymore at the end, which is a very appealing thought.  The actuality of the interview however was as unpleasant as any huge skid you can imagine.  It forced me to think about all the things about me and that I do that really are horrible smears in my life.  By the end I felt pretty crap (excuse the pun).

Role on the end of DBT!

Base camp

If this is what pre-commitment is like, then what the blazes am I letting myself in for doing DBT?  Session three was hard!

Of course hard and bad are entirely different things.  Last week, after session two I was on the verge of pulling out.  Last week was bad.  This week, I think I am up for the journey.  The session was hard but I am left feeling that there might be a way forward after all.

I made a choice this week, after last week’s session and the awful few days that followed.  I chose to give Joy a chance and allowed myself to be very honest with her – even to the point of admitting I’d failed to achieve my goals in a big way and that I felt one of the exercises we tried was a bit stupid.  For me it was an immensely massive risk that paid off.  Joy was okay about it and now I can go at a more manageable pace.

The DBT path still looks huge, daunting and so high I can’t see the top of the mountain.  Above the tree line there are sharp rocks and snow.  I pray there is a trail to scramble and I won’t have to actually climb – but I can’t see it.  The snow vanishes into the clouds.  It looks extremely steep.  The lower mountain is clad with trees – a tightly packed forest that lets little light in.  It smells musty, damp and it’s so quiet.  All sound is muffled as if I am trapped in a box.  It is terrifying.  It is an adventure.

In my twenties I was hooked on outdoor pursuits.  I loved rock climbing and especially white water kayaking.  I took up kayaking because I was scared of water.  Even then I lived with the BPD tension of wanting to die and wanting to overcome.  Kayaking was the ideal solution.  Either I overcame the fear or I died in the attempt.  That’s probably not entirely logical, but it made sense at the time.  The outcome was that I became pretty good at Kayaking (level 4 inland and sea).  I reached a stage where I could not push myself beyond my fear to stretch my skills any further.  I had overcome my fear as far as I possibly could (and I was still scared of big water).

Somehow, I need to find that adventurous spirit again so I can take some big risks and push myself well out of what is comfortable to reach the top of my mountain.

In at the deep end....

I feel like I’ve been run over by a double decker bus.  I’m exhausted, wrung out and would either like to curl up and hide somewhere or weep in a corner. 

I’m not used to a therapist like Joy.  Joy says it’s ok to feel overwhelmed – that’s the purpose of the pre-commitment therapy, to build a foundation and rapport with the therapist that makes it possible to succeed with an intensive therapy like DBT. 

To me Joy lacks a softness in her approach.  For example, John would challenge me on something, even lecture me – but he’d soften it with a comment like “I bet you think I’m picking on you now?”  I would say yes, and then we could negotiate.  Joy bulldozes on!  I know what she says is right, and I would like to achieve the things she is suggesting – but it all feels too much too fast.

She keeps saying to me that “it’s up to me” and “it’s ok to negotiate”, and to tell her what is realistic for me etc. but it doesn’t ring true.  I feel pushed.

I don’t know if you are familiar with speech act theory.  It is basically the action a phrase or word provokes rather than the meaning of the words in a literal sense.  Let me give you an example:  Someone walks in through a door leaving it open.  I say,

“Were you born in a barn?”  The person shuts the door.  The speech act was shutting the door (the action triggered by the words).  Literal meaning is irrelevant – I had no desire to know whether that person was born in a barn, hospital or anywhere else.  The purpose of the words was an action and not a question or even a direct request.

Joy is a master of this!  For example, in my anxiety I shredded a bit of paper I was holding into 2mm square bits which were dropping everywhere by the time I’d finished.  She said,

“There’s a bin over there.  You can put them in if you want to – it’s completely up to you!”  I complied with the required action and put them in the bin.  I went on to peel my fingers instead.   

Perhaps it will all feel a little less overwhelming tomorrow.